Kaumatua Workforce Strategy for Mental Health and Addiction Services - Te Rau Ora
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Whiria Te Oranga Kaumatua Workforce Strategy for Mental Health and Addiction Services
Whiria Te Oranga
Whiria Te Oranga recognises the leadership of kaumātua to support the well-being
of tangata whaiora, whānau, hapū, iwi, mental health and addiction workers and
services. Whiria Te Oranga encompasses the weaving of health and well-being for
the young and old; the skill of kaumātua to negotiate obstacles that may
impede pathways to successful health outcomes for individuals and families,
relationships between services, whānau, hapū, iwi and Māori communities.
He Korowai Ariki, a traditional cloak that is a highly refined garment, richly
adorned and known for its beauty, was preserved to be worn by those considered to
be of senior status. He Korowai Ariki is portrayed here t o represent the senior roles
of kaumātua, koroua me kuia in Māori society today. Senior status is often
associated with wisdom, depth of knowledge, experience, teaching ability,
guidance, leadership and chieftainship (Te Rau Matatini, 2007a).
The korowai fosters, promotes, and maintains the kaupapa to generate the bringing
together of a number of genre to acknowledge and promote positive relationships
and mental well-being (Taiarahia Black, 2006).
About the Cover
Our special thanks and acknowledgement to Veranoa Hetet (nō Te Atiawa, Ngāti
Tuwharetoa, Ngāti Maniapoto) for permission to use an image of her creation of
korowai taonga. The korowai was a collaborative work with her mother Erenora
Puketapu-Hetet (who wove the korowai featured on the cover of the National
Māori Health Strategy He Korowai Oranga). Veranoa, a registered Toi Iho
traditional and contemporary weaver who has exhibited extensively, is a tutor of
Māori Design and Art with the Open Polytech of New Zealand.
Whiria Te Oranga
Kaumatua Workforce Strategy
for Mental health and Addiction Services
TRM/05/26a
FUNDED BY MINISTRY OF HEALTH
WRITTEN BY LOUISE IHIMAERA
COVER DESIGNED BY MAUI TAEWA
Published in April 2008 by Te Rau Matatini
ISBN: 978-1-877412-08-0 (Book)
ISBN: 978-1-877412-13-4 (Web)
This document is available on the website of Te Rau Matatini www.matatini.co.nz
Te Rau Matatini, PO Box 12175, Palmerston North
“They help us feel real safe on marae, teach us kawa and tikanga
and give us our own serenity.”
“He has a very cheeky way that lightens up the atmosphere
and knows when to be serious and through his kōrero puts
everyone on the same level of understanding.”
“She has the ability to smooth the waters.”
From the mental health and addiction workforce
KORERO WHAKAPUAKI: FOREWORD
Tēnā koutou
The role of kaumātua as community leaders has long been familiar on marae and
within iwi. Importantly, health services have also realised how valuable kaumātua
can be as part of the health team. In mental health and addiction services,
kaumātua are even more highly valued because of the increased relevance of
culture to health outcomes.
This document outlines some of the roles kaumātua can play and the contributions
they can make to health gains for Māori. Most kaumātua employed in health
services have advanced cultural knowledge and skills. But in addition they will
be increasingly expected to have a sound understanding of clinical processes and
service parameters so that their contribution can be felt across the whole treatment
and care process.
Further, because of the important role they play as advocates, as contact points
with Māori communities, and as senior members of the team, they have the
potential to promote a spirit of integration and integrity.
Building on three strands, this strategy identifies a number of key whānau ora
contributions and practice indicators that can form the basis for a kaumātua
workforce strategy – at least in respect to mental health and addiction services.
The document is one of a series that examines workforce needs for Māori mental
health, and has been prepared as a guide for services, and for kaumātua who will
work in those services.
Kia maia
Mason Durie
i
POROPOROAKI
TRIBUTE TO BOB HENARE AND DENIS SIMPSON
Kei te ahei ngā tau o te ata
Kei te patukituki ngā ta rama
Kei te hotu te hotu manawa
Kei te moteatea ngā mahara
Mō koutou ngā tangata o te motu
Kua huri kaweka nei
Aue! Taukiri e!
The following is a tribute to the late Bob Henare and Denis Simpson and their
significant influence on national mental health and contribution to whānau ora.
Bob Henare was interviewed on 31 May 2007 because of his work experience and
his working relationship with Denis Simpson. The Simpson whānau joined with
Bob at the interview to remember his contribution as the Kaumatua for the Mental
Health Commission.
BOB HENARE
Nō Ngā Puhi me Ngāti Hine
Motatau Te Marae
Mental Health Commissioner 1996–2006
Bob Henare was appointed as a Mental Health Commissioner by Hon. Jenny
Shipley, at the inception of the Mental Health Commission, and saw the opportunity
to contribute to a new way forward: “I always believed that if you get the Māori
mental health system right then the mental health system in this country would be
right. There has been a tendency in the past for the service to exist for itself rather
than the people it is there to serve… we were modifying the system for the
consumer not for the system itself”, quoted in Te Haerenga mo te Whakaoranga
1996–2006 (Mental Health Commission, 2007).
When asked during the interview for advice to those working in mental health and
addiction, he replied immediately, “Move the goal posts one inch. Small changes do
make a huge difference”
Herea to waka ki te whetu, kaua e herea ki te tokerama
Tie your canoe to a star and not to a glow-worm ~ Tā Hemi Henare
ii
DENIS SIMPSON
Maataatua te waka
Ngāti Awa te iwi
Ngai Taiwhakaea te hapū
This tribute to Denis Simpson is a celebration of the
importance of kaumātua in the mental health sector.
It was brought together with the guidance and input
of the Simpson whānau and the late Bob Henare,
former Mental Health Commissioner (1996–2006).
“In terms of leadership as the Kaumātua for the Mental Health Commission, Denis
set the scene for all hui, gave the Commission credibility and played an important
part in having people understand what the Commission was about. He became a
father figure to the whole of the Commission and had the blessing of the
Commission to talk about the Commission as he was well trusted. Denis provided
opportunity for those [at the Commission] who wanted to learn about ngā mea
Māori [things Māori]... He [had] a deep empathy and feeling for those who were
experiencing mental illness and became an advocate for consumers. He was very
strong in his views and made no bones about it and encouraged others to do the
same and to know what they were talking about. Denis was always clear about his
role as a kaumātua. He was very respectful of those he worked with and was very
knowledgeable about the communities we travelled to. He always knew someone in
each community. I remember when we visited the prisons, Denis wouldn’t hesitate
talking to the inmates. He didn’t ignore them or cast them aside. He’d sit and talk
and he always got a smile and a laugh” (Bob Henare, 31 May, 2007).
The Simpson whānau shared that Denis took his role very seriously, was always
immaculate in his dress and very thoughtful of those he worked with. “At
Christmas he would buy individual gifts for those he worked with and carefully
wrap each one down the back in his shed... I found out at his 80th birthday, that he
was a big part of mental health. I’m a support worker in mental health. It’s at my
own pace, of my own choice, that’s what he always said. He wanted his children,
his grandchildren to make their own way” (Mokopuna, Natasha, 31 May, 2007).
iii
MANAKOTANGA: ACKNOWLEDGEMENTS
Mai i Rangiātea i heke iho te mana i ngā apākura ki a Rangi rāua ko Papa, ki ō
tātou tūpuna, tae noa mai ki a koutou e koro mā e kui mā nō te kāhui koroua me
kuia hei korowai mō te tangata te whānau te hapū te iwi. Otirā ki a koutou ngā
marae ngā whare hauora hinengaro ngā mana whenua e tautoko ā wairua ā hinengaro
ā tinana mai ana i tēnei kaupapa Whiria Te Oranga arā te whakawhanaketanga
te whakapuāwaitanga o te rāngai koroua me kuia e mahi ana kei roto i te whare
hauora hinengaro, tēnā koutou tēnā koutou tēnā koutou katoa.
Te Rau Matatini acknowledges the manaakitanga and whanaungatanga that has been
provided by marae, Māori organisations, whānau, hapū, iwi, district health boards
(DHB’s), and non-government organisations (NGO) and Māori mental health and
addiction services who attended and participated in and/or hosted the:
• Kaumātua, koroua, kuia, whaea, pakeke and rangatahi workforce
development forums held at Te Rau Tipu Conferences in 2004 and 2006
• Whiria Te Oranga consultation hui attended by kaumātua, tangata whaiora,
whānau, clinicans and managers held at Te Whare Marie Wellington, Whakatū
Marae Blenheim, Waiora Trust in Christchurch, Te Taiwhenua o Heretaunga
Hastings, Terenga Paraoa Marae Taitokerau, Mahi Tahi Trust Auckland, and
Kirikiriroa Marae in Hamilton in 2005 and 2006
• Kaumātua and whānau who were interviewed to provide the case study
exemplars in 2007
• Kaumātua, koroua me kuia, senior managers, Māori clinicians, tangata whaiora
and whānau who contributed to the development of the Whiria Te Oranga
workforce strands in 2008.
Special thanks also to Te Rau Tuku Iho Reference Group members and Te Rau
Matatini Trust who shaped and guided the development of this work; and to Matua
Raki for Pam Armstrong’s support. All your input, participation, and
contribution has been fundamental in the development of Whiria Te Oranga
Kaumātua Workforce Strategy and the underpinning of kaumātua workforce
strands, whānau ora contributions and key practice indicators.
iv
IHIRANGI: CONTENTS
Kōrero Whakapuaki: Foreword i
Poroporoakī: Tribute to Bob Henare and Denis Simpson ii
Manakotanga: Acknowledgements iv
Kōrero Whakataki: Executive Summary 1
Kaupapa: Philosophy 2
Kōrero Whakataki: Introduction 3
Kaumātua Workforce Profile 4
Strengthening the Foundations 5
Kaumātua Workforce Strands 7
Kaumātua Assisting Tangata Whaiora in their Journey to Recovery 10
Kaumātua Contribution to Mental Health and Addiction Services 14
Kaumātua Workforce Development 24
Ngā Whakaaro Whakanunui: Workforce Factors to Consider 39
Kōrero Whakaoti: Conclusion 40
Ngā Matapuna: References 42
Appendix One: 2006 Consultation Hui and Numbers 45
2007 Participants in Case Study Exemplars 46
Appendix Two: Te Rau Tuku Iho Reference Group Members 51
Appendix Three: National Health Policy and Kaumātua 52
Workforce Development
KORERO WHAKATAKI: EXECUTIVE SUMMARY
Whiria Te Oranga is intended for kaumātua (koroua, kuia me whaea), managers
and clinicians working in mental health and addiction services and DHB funders
and planners who purchase the services.
The Strategy funded by the Ministry of Health aims to provide a guide on the
many important and valuable contributions kaumātua provide to mental health and
addiction services and identifies the unique workforce
development needs of kaumātua.
1. Whiria Te Oranga aligns to Kia Puāwai Te Ararau, the national Māori
Mental Health Workforce Development Strategic Plan (Te Rau Matatini,
2006a) and recognises kaumātua contributions to the mental health and
addiction sector and the essential role of kaumātua in supporting cultural
responsiveness to tangata whaiora and whānau, and through doing so,
enhancing best health outcomes.
2. The kaumātua workforce profile indicates that kaumātua remain
significantly under-represented. Recruitment and retention of Māori staff is
unbalanced, given the high demand from Māori for services.
3. Kaumātua workforce roles, when fully realised and appropriately
implemented, will provide a supportive environment for mental health
and addiction practice and accountability under the Health Practitioner
Competency Act 2003.
4. A framework encapsulating the breadth, depth and variation of kaumātua
roles in mental health and addiction is based on the following three
workforce strands: kaumātua assisting tangata whaiora in their journey to
recovery; kaumātua contributions to mental health and addiction service
development; and kaumātua workforce qualities and skill sets. These are
detailed further through areas of whānau ora contribution and key practice
indicators.
5. Kaumātua case studies acknowledge local workforce solutions and
initiatives that support and enhance kaumātua workforce priorities and
provide best practice exemplars.
1KAUPAPA: PHILOSOPHY
MA TE WHAKAPAKARI I TE HUNGA HAPAI,
E PIKI AI TE HAUORA HINENGARO O TE WHANAU
TO STRENGTHEN THE MAORI WORKFORCE TO
MAXIMISE MENTAL HEALTH GAINS FOR WHANAU
Whānau ora is the ultimate pinnacle where Māori families are “supported to achieve
their maximum health and well-being” (Ministry of Health, 2002a, p. 1). A recovery
approach is consistent with whānau ora. Both philosophies enable and promote
support and choice and, also advocate for changing of disabling behaviours,
attitudes and practices in the workforce and communities.
Equally, they embrace respect for Māori cultural values, knowledge, and social
systems. It is essential therefore that the kaumātua workforce provides whānau ora
and recovery-focused care that is culturally appropriate and inclusive of whānau
participation in the health system.
This vision recognises that whānau well-being is central to Māori well-being and to
positive and healthy outcomes for Māori. The vision also anticipates that the Māori
mental health workforce located in both dedicated mental and addiction
services and the wider health and social support services are valued for their
cultural, social, and clinical expertise that contributes to best health outcomes for
Māori.
NGA MINENGA MATUA: KEY AUDIENCES
Whiria te Oranga has been developed to:
• guide kaumātua practice through three strands that clarify roles, associated
whānau ora contributions and key practice indicators
• inform tangata whaiora and whānau about how effective kaumātua practice will
support personal health and cultural gains
• reinforce to the mental health and addiction sector that kaumātua are cultural
specialists and are able to add value through kaumātua interventions that can
improve cultural responsiveness by services and positive health outcomes for
tangata whaiora and whānau.
2KORERO WHAKATAKI: INTRODUCTION
KA TIKA TE HUARAHI O MURI
KA TOTIKA ANO TE HUARAHI O MUA
WITH THE PATHWAY OF THE PAST
THE PATHWAY FOR THE FUTURE WILL BE RIGHT1
Kaumātua carry responsibility as leaders in the community and the workplace and
as ‘custodians of Māori culture’ to safeguard and transfer traditional knowledge for
future generations (Te Rau Matatini, 2005). Through sharing their expertise and
leadership in cultural matters (ngā mea tikanga), kaumātua have been recognised
as important resources for supporting the mental health and addiction workforce
in service delivery, planning and development and oranga whānau (Mental Health
Commission, 1998a; Te Rau Matatini, 2004).
“To be a kaumātua, you must first wade through life, because that’s what the
word means: to wade through something. And only when you wade through can
you begin to understand life and the context of life. Then you start getting older
and older and older, and then you get the standing of a kaumātua, when you have
walked through the concept of the Māori world” (Moon, 2004, p. 118).
It is notable that for a number of decades kaumātua have been working for Māori
health, language and economic development (Hui Whakaoranga, 1984; Black,
Marshall & Irwin, 2003; Hui Taumata, 2005). Kaumātua have also helped to guide
and develop Māori health services, have worked to create better health outcomes
for Māori, and protected and preserved te ao Māori (the Māori world) (Milne,
2001). Māori communities have looked towards kaumātua to provide and support
the direction communities need to take in areas of social, political, spiritual and
economic development (Walker, 1989; Durie et al., 1996).
Kaumātua contributions to mental health and addiction workforce development are
not exclusively for Māori workers or services. Kaumātua are actively pursued and
employed to advise Māori and non-Māori mental health and addiction teams and
services and at all service levels. Contributions include kaumātua consulting and
advising at executive and management levels to service teams, individual
workers and with tangata whaiora and whānau. It is becoming increasingly evident
that kaumātua play an important part in the effectiveness and responsiveness of
New Zealand’s mental health and addiction services and the development of the
workforce.
1 Broughham, A.E. & Reed, A.W. (1991) The Reed book of Māori proverbs: Te kihikohanga whakatauki a
Reed. Auckland, New Zealand: Reed Publishing (NZ)
3The term kaumātua generally refers to older Māori people who have earned the
respect of their whānau, hapū and iwi (Te Puni Kōkiri, 1999). Although a formal
process does not exist to appoint elders to kaumātua roles in their communities,
there are unwritten guidelines (Durie, 2001). These include looking for people
who have strong leadership skills, the respect of the whānau, strong te reo Māori
skills, and knowledge of tikanga and customs (Durie, 2001).
Kaumātua knowledge of te ao Māori develops over time through life experience
and teachings from elders. Many kaumātua naturally take on leadership roles in
their whānau, hapū, iwi, and community and it is important that their contribu-
tion is recognised appropriately (Durie, 1999; Waldon, 2004). There are others,
however, who may not be as confident in a kaumātua role and this could be due to
a number of reasons, including isolation from one’s own whānau, hapū, iwi and
community, or diverse lifestyles that have not allowed for active participation in te
ao Māori.
Ideally, it is for whānau, hapū, iwi and Māori communities to decide who is a
kaumātua. It is not a role that should be decided on by an individual. When
kaumātua are employed to undertake work in agencies, the nature of the role and
the skills needed, are not always well defined. While research shows that kaumātua
have been pivotal in Māori development, the needs of kaumātua working in mental
health and addiction services are often over looked (Milne, 2001; Te Rau Matatini,
2005; Te Rau Matatini, 2006a; Te Rau Matatini, 2007b).
KAUMATUA WORKFORCE PROFILE
Workforce development is not new to kaumātua. Many have spent the greater
part of their lives working in other sectors in various occupational roles.
Negotiation of job responsibilities, remuneration and upskilling is often familiar
territory. However, securing fair conditions of employment for kaumātua
working in health services is varied. Some services have well developed processes
to support kaumātua roles, while others struggle to recognise the value of the role
of kaumātua and/or are unsure of how to define or approach issues such as role
clarity, remuneration, and workforce development supports.
4STRENGTHENING THE FOUNDATIONS
Although there is little statistical data at this time about the kaumātua workforce in
mental health and addiction services, it is estimated to be 8% (or 192) of the Māori
mental health workforce. There are approximately 2400 Māori mental health
workers in total (Hirini & Durie, 2003; Te Rau Matatini, 2008a)..
The over-representation of Māori in mental health facilities and greater psychiatric
prevalence in the community highlights the need for effective services and a
workforce that is well equipped to respond to the needs of tangata whaiora and
whānau. Essential to this is the recognition and building of the kaumātua
workforce and their roles.
Over the past 4 years Te Rau Matatini has consulted and investigated extensively
with kaumātua, koroua me kuia, whaea and pakeke, managers, clinicians, tangata
whaiora and whānau on the contributions that kaumātua, koroua me kuia make to
tangata whaiora, and their whānau and mental health and addiction services. From
this, three kaumātua workforce strands with areas of whānau ora contribution and
key practice indicators were developed:
• Kaumātua assisting tangata whaiora in their journey to recovery
• Kaumātua contributions to mental health and addiction services, and
• Kaumātua workforce qualities and skill sets.
The above workforce strands recognise the importance of effective kaumātua
practice in supporting and achieving whānau ora when working in mental health
and addiction services. Kaumātua involvement in the strategic direction of mental
health and addiction services for Māori and service delivery is important
(Mental Health Commission, 1998b; Rangiaho, 2003; Ihimaera, 2004).
THE ROLE OF KAUMATUA
Kaumātua contribute in many ways to mental health and addiction services. They
often play an important role in working directly with tangata whaiora and whānau,
as well as guiding the development of assessment programmes, service delivery,
5“Lessons of keeping to the kaupapa of looking after the tangata, and
working together to uplift and uphold the mana of the tangata is found in the
richness of the kōrero from the marae, from te ao Māori as handed down to us by
these koroua.” Referring to Matua Panataua, Ben Rangitaawa me
Matua Bob Elliott, Kirikiriroa
leadership, provision of cultural
guidance, and support the development
of dual competency for mental health and addiction staff to create a culturally safe
environment for tangata whaiora, whānau, and the services (Ihimaera, 2004;
Rangiaho, 2003; Mental Health Commission, 2001; Te Rau Matatini, 2004;
Ihimaera & Tassell, 2004; Milne, 2001). Kaumātua contributions to services and
whānau therefore support cultural outcomes as an integral part of health outcomes.
The range of tasks kaumātua undertake in mental health and addiction
services takes into account the individual experiences, skills, knowledge, and
qualities that kaumātua bring with them to the workplace (Durie, 2001). Although
kaumātua bring personal strengths, some core skill sets are required of kaumātua,
as expressed by kaumātua in the consultation hui (Te Rau Matatini, 2007a), in case
study interviews, and in reports undertaken of kaumātua working in mental health
(Ihimaera, 2004; Rangiaho, 2003).
The workforce strands are underpinned by the following areas of whānau ora
contribution. These serve to detail further the scope of kaumātua involvement in
mental health and addiction services:
• Tangata whaiora and whānau engagement
• Service approaches to tangata whaiora and their whānau
• Tikanga Māori interventions
• Social inclusion
• Balance in the recovery journey of tangata whaiora and their whānau
• A conduit to whānau, hapū, iwi and Māori communities
• Integration of teams
• Multidisciplinary team meetings
• Tikanga Māori leadership and oversight
• Cultural supervision/mentorship
• Cultural fluency
• Clinical knowledge
• Understanding and knowledge of the mental health sector
• Engagement with local iwi and/or Māori communities, and
• Māori workforce development.
6WORKFORCE STRANDS
Kaumātua Whānau Ora Key Practice Indicators
Role Contributions
1. Tangata whaiora 1. Kaumātua are accessible, able to relate to, and manaaki
Kaumātua and whānau tangata whaiora and their whānau
Assisting engagement 2. Kaumātua can advocate for tangata whaiora ‘voice’,
Tangata personal choice and personalised recovery plans that are
Whaiora in culturally relevant
Their Service 3. Kaumātua are able to advocate for whānau
Journey to approaches to participation in the health system
Recovery tangata 4. Kaumātua can ensure that communication between
whaiora and their whānau, services and Māori communities is relevant,
whānau clear and meaningful
5. Kaumātua ensure that services are culturally appropriate
and beneficial to tangata whaiora and whānau
6. Kaumātua monitor the quality of cultural assessments
that are offered and the information from the
assessments are converted into positive health actions
Tikanga Māori 7. Kaumātua are able to facilitate a culturally safe
interventions environment for tangata whaiora and whānau through
effective provision of pōwhiri, karakia, manaaki
whakawhanaungatanga, and whakapapa
8. Kaumātua can facilitate access and choice for tangata
whaiora and whānau to other kaumātua, choice of
cultural treatment and healing options inclusive of
traditional treatment and healing practices
Social 9. Kaumātua are able to facilitate access to hapū, iwi, rohe
inclusion and/or Māori society for tangata whaiora and whānau
10. Kaumātua can assist tangata whaiora and whānau to
relevant whakapapa (genealogies)
Balance in the 11. Kaumātua are able to distinguish between cultural
recovery norms and symptoms of disorder
journey of 12. Kaumātua are able to recommend interventions that
tangata whaiora will alleviate culturally based distress
and their whānau
7Kaumātua Whānau Ora Key Practice Indicators
Role Contributions
2. A conduit to 13. Kaumātua are able to ‘open doors’, establish
Kaumātua whānau, hapū, relationships, and facilitate linkages between services
contribu- iwi and Māori and whānau, hapū, iwi, and Māori communities
tions to communities 14. Kaumātua are able to mediate effectively between
mental services and Māori on cultural matters to advance
health and beneficial health programmes
addiction
Integration of 15. Kaumātua are able to support senior management to
services
teams bring a team together and facilitate culturally responsive
outcomes for tangata whaiora, whānau and the service
16. Kaumātua are able to successfully advocate for a
collaborative interagency approach for positive service
delivery results
Multi- 17. Kaumātua are able to offer advice about culture in
disciplinary team relationship to mental disorders and addiction
meetings 18. Kaumātua can identify and assess cultural factors and
are able to lead discussion on the significance of culture
to clinical conditions
Tikanga Māori 19. Kaumātua are knowledgeable about tikanga Māori and
leadership and can teach and oversee other Māori staff to facilitate
oversight pōwhiri, karakia, manaaki, whakawhanaungatanga, and
cultural assessments
20. Kaumātua are able to lead pōwhiri, karakia, and
whakawhanaungatanga on behalf of the team, services/
organisation
Cultural 21. Kaumātua are able to assess cultural competency of
supervisor/ other team members
mentor
22. Kaumātua can provide effective cultural supervision and
mentoring for the team and/or individual practitioners/
managers, which gives balance between the cultural
and clinical dimensions of mental health and addiction
practice
8Kaumātua Whānau Ora Key Practice Indicators
Role Contributions
3. Cultural fluency 23. Kaumātua are knowledgeable about te reo Māori me
Kaumātua ōna tikanga, Māori ethics, customs, philosophies, and
workforce communities to uphold tikanga and can advise on
qualities appropriate kawa
and skill 24. Kaumātua can speak confidently in te reo Māori and
sets will be able to use both English and Māori to build
mana and strengthen cultural identity
Clinical 25. Kaumātua understand tangata whaiora and
knowledge whānau-related policy and philosophies and are able to
apply them appropriately to practice
26. Kaumātua are well placed to inform whānau, hapū, iwi
and Māori communities about mental health and
addiction issues
Understanding 27. Kaumātua are knowledgeable about the broad
and knowledge of parameters of Māori development and implications of
the mental health mental health problems and addictions for Māori
sector 28. Kaumātua are able to provide cultural input into the
choice of measures used in the care and treatment of
tangata whaiora
Engagement iwi, 29. Kaumātua have the support of local iwi or Māori
and/or the Māori community in their role for the services
community
Māori workforce 30. Kaumātua can inform and contribute to Māori
development recruitment and retention strategies to assist managers
to progress Māori workforce development
31. Kaumātua are able to advise on Māori phrases,
whakatauākī, symbols, imagery, and captions relevant
to Māori audiences
32. Kaumātua are able to build and promote a sense of
whanaungatanga across Māori workforce development
initiatives
33. Kaumātua can endorse promotional material including
profiles and career pathways
9KAUMATUA ASSISTING TANGATA WHAIORA IN
THEIR JOURNEY TO RECOVERY
TANGATA WHAIORA AND WHANAU ENGAGEMENT
Gaining access to mental health and addiction care continues to be a challenge.
Māori access can be impaired for economic, geographic, social and cultural
reasons. Kaumātua ability to engage with families helps to reduce the access
barriers causes by cultural alienation. It is important therefore that services are
resourced so that kaumātua can support tangata whaiora and their whānau.
Whanaungatanga is an essential cultural element in establishing, engaging and
maintaining relationships. Whanaungatanga also provides a sense of belonging,
identification and strength. When initiated and undertaken well, it supports te taha
wairua and can enable tangata whaiora and whānau to kōrero and share personal
health information (Ihimaera, 2004).
Culture is an integral aspect of recovery planning and kaumātua need to know how
cultural interventions can best contribute to recovery. A recovery-oriented practice
must be:
• person oriented
• holistic
• able to promote individual decision making and responsibility
• able to offer choice and empowerment
• linked to self-management
• oriented towards hope
• geared towards positive mental health
• built on positive relationships between individuals and the community
• inclusive of whānau members, and
• mindful of the perspectives, aspirations and values of whānau.
SERVICE APPROACHES TO TANGATA WHAIORA AND
THEIR WHANAU
Service appropriateness and an appreciation of culture and cultural identity are
key to the delivery of services that will uphold the mana and the dignity of tangata
whaiora and whānau. There are a number of ways kaumātua are able to ensure that
assessment, treatment, healing, and discharge processes uphold the dignity of
tangata whaiora and their whānau.
10“In mental health planning we have what we call the “Johnny strategy”
because many times he is our strategy! He has a different way of
thinking to our younger generation. When we are planning we would be a
lot clearer if we thought like him; and he always gives a whakapapa to his
whakaaro.” Referring to Matua Johnny Coleman, Ngāti Porou Hauora
Kaumātua can advise on service protocols
that include cultural workers at the first assessment or
on entry to the services and for those who undertake cultural assessments.
Where such clinical and cultural interventions take place, kaumātua are able to
advocate for tangata whaiora and contribute to personalised recovery plans that
will produce positive health outcomes. Kaumātua can also ensure tikanga
processes such as whanaungatanga, manaaki and karakia are offered to tangata
whaiora and whānau and to assist with their recovery journey. Where tangata
whaiora and whānau choose not to have cultural interventions, kaumātua and
health practitioners will respect that.
At times and as appropriate kaumātua will also have an important role in
advocating for whānau in aspects of service delivery such as the cultural
assessment or the evaluation of access to service and suitable service delivery
modes for their whānau member. The inclusion of whānau as part of the recovery
journey will add an element of accountability that will strengthen the central
purpose of a mental health service, namely, to improve outcomes for tangata
whaiora (Te Rau Matatini, 2007b).
TIKANGA MAORI INTERVENTIONS
As carriers of tikanga Māori (culture) the kaumātua workforce is in a unique
position. There is a general understanding that much of what a kaumātua does is
with te taha wairua (the spiritual elements) and this would be one of the first
qualities that other Māori may look for when working with kaumātua. Māori have
a holistic approach to health and wellbeing and an appreciation of spirituality from
a Māori world view is essential.
Tikanga Māori interventions such as karakia, pōwhiri, manaaki, whakawhanau-
ngatanga, whakapapa, and the use of te reo Māori may contain spiritual, mental,
physical, and whānau elements. When facilitated appropriately these elements can
assist all facets of health care and treatment and build and strengthen identity as
well.
11Karakia has been known to open up the way for wairua ora influences. This in turn
produces a calming effect for the tangata whaiora and whānau and healing may
begin (Ihimaera, 2004). An Oranga Matrix was developed in 2003 to assess the
positive effects of the influence of taha wairua in mental health services (Ihimaera,
2004).
The Matrix shows benefits arising from the use of tikanga Māori.
Oranga: Significant benefits for tangata whaiora and whānau through the
influence of taha wairua as facilitated through tikanga processes
Tikanga Healing aspect Mental health Benefits
Processes interface
Pōwhiri Reduces space and On admission to Quicker recovery from
distance for meaningful service short-term psychotic
interaction to occur episode
Karanga Creates a sense of On initial contact Opportunity for a new
cohesion between physical and beginning to a life of
spiritual domains wellness
Karakia Establishes a bond and In all cultural and clinical Allows for passage to
creates a sense of unity interactions facilitated by sharing of issues; shedding
between tangata whai ora workers, tangata whai ora of guilt and shame; to gain
whānau and the spiritual or whānau insight into illness
dimension
Whakawhanau- Establishes helpful Particularly useful in Permits use of
ngatanga relationships between assessment and traditional stories,
individuals, whānau and treatment and laughter, scolding, and
mental health workers rehabilitation phases of allows for deeper
care bonding between parties
Whakapapa Acknowledges significant In all cultural and clinical Sanctions whānau
relationships of kin and interactions involvement in all
non-kin persons aspects of care
Te Reo Māori Encourages use of the Māori Especially useful in Supports Māori to
language to express feelings de-escalation of comfortably participate in
and concerns and share challenging situations treatment
sensitive issues
Karakia, te reo The combination of tikanga In all cultural and Minimises the use of
Māori, practises appropriately clinical interactions but legislation, i.e. Mental
cultural worker, facilitated offers protection gives added value in ‘high Health Act and seclusion
kaumātua, and safety risk’ situations
tohunga
(Ihimaera, 2004, p. 97)
12“There is no question that we need to invest in our future and invest in an
inclusive way where there is space and a place for everyone…I believe to
become a Kaumātua there is a beginning point, a middle point but I don’t
know that there is an end point. – I consider myself a Māori Disability
Activist” Maaka Tibble (Ngāti Pōrou) Tairawhiti DHB
SOCIAL INCLUSION
Social inclusion is a core component of recovery. It is much more than just living
in a community. It is about being able to participate in a community and having a
sense of belonging to that community (Mental Health Commission, 2007).
Being included in group activities such as community and whānau occasions,
having employment that provides a reasonable and regular income, safe and
comfortable housing, participation in recreational events and enjoying a measure
of independence are all measures of societal inclusion (Te Rau Matatini, 2008b).
Being included also provides an opportunity for greater understanding and
acceptance by whānau, hapū, iwi, and communities of the negative impacts of
experiencing mental health and addiction issues. This acceptance can help reduce
stigma and discrimination for tangata whaiora and whānau. In order for kaumātua
to facilitate access to hapū, iwi, and community, kaumātua must have a good
understanding of Māori networks and key contacts.
BALANCE IN THE RECOVERY JOURNEY OF
TANGATA WHAIORA AND THEIR WHANAU
Kaumātua are cultural specialists and can contribute to the treatment team in many
ways. Cultural knowledge enables kaumātua to distinguish between a normal
cultural response and symptoms of a disorder. Sometimes behaviour or thinking
processes will be considered abnormal if there is a lack of cultural comparison
between clinician and service user. Identifying the significance of culture in a
recovery journey is an important kaumātua task. Where a cultural problem exists
alongside a clinical problem, the kaumātua and the clinician should discuss how
each aspect might be best managed and, if necessary, which aspect should be
afforded greater priority.
13KAUMATUA CONTRIBUTION TO MENTAL
HEALTH AND ADDICTION SERVICES
A CONDUIT TO WHANAU, HAPU, IWI AND MAORI
COMMUNITIES
Establishing and maintaining useful relationships between mental health and
addiction services and whānau, hapū, iwi, and Māori communities is vital to
increase the opportunity for Māori participation in mental health and addiction
service delivery and in the sector.
Access to Māori communities has a number of prerequisites – these may include
kaumātua needing to advocate for Māori community participation and breaking
down barriers that may exist between the services and the Māori community.
It is valuable therefore to have kaumātua with the experience and background to
speak with some certainty about circumstances that affect whānau, hapū, iwi, and
community issues and advise management on how best to begin relationships and
how to progress those relationships. This might involve kaumātua resolving past
and future conflicts, maintaining cultural protocols and providing cultural advice,
reception and care of visitors and the performance of ceremonial duties for and
behalf of services.
Opening doors to whānau, hapū, iwi, and the Māori community is not always a
comfortable responsibility for kaumātua and recognition of the negotiation skills
required as well as the community’s trust of the integrity of the kaumātua should
be acknowledged. Māori communities becoming more informed and involved can
encourage local ownership of health issues and agreement to participate in joint
health initiatives to be proactive and improve access for their whānau to health
services.
14“We as kaumātua have played a very strong part in ensuring that cultural assessment
has become firmly embedded into the practice for Māori who are accessing mental
health. It is also important knowing that there is a distinct difference between a Māori
assessment and a clinical assessment, having good relationships between Māori and
mainstream services has helped mainstream to support what we do.”
Wairau Nelson Marlborough Kaumātua Roopū
INTEGRATION OF TEAMS
“The primary care sector is a logical place
for the delivery of mental health care. It offers better prospects of early
intervention and the management of comorbidities, and is more likely to have
closer ties with community agencies such as schools, marae, and recreational
centres” (Te Rau Matatini, 2007b).
Kaumātua with strong networks to Māori communities and organisations can take a
mediatory role between services and Māori on cultural matters that affect whānau
early uptake of services to achieve mutually beneficial integrated health care
initiatives. Kaumātua also play a strong role in promoting and raising awareness of
Māori mental health issues and initiatives that will support positive health
outcomes for tangata whaiora and whānau.
Primary health care is the first level of contact an individual, whānau and
community have with the formal health system, and it begins the continuing health
care process. Integration has two meanings, seamless continuity of care, and the
acquisition of mental health knowledge and skills by primary care workers so that
mental health intervention can be effectively delivered in primary care settings
(Te Rau Matatini, 2006a).
On a service delivery level there are two ways kaumātua can participate and
influence positive change. One way is to support senior clinicians to bring a team
together to achieve positive cultural responsive outcomes for tangata whaiora and
whānau. This will require kaumātua to have an understanding of what primary and
secondary care is and what part each plays in achieving good health outcomes for
Māori; it will also require kaumātua to have robust relationships with tangata
whaiora and whānau. Kaumātua may advocate for and secure agreement with
tangata whaiora and whānau on the benefits of an integrated care plan. A positive
outcome would be realised by having in place an integrated care plan that would
have clearly defined assessment, treatment and care responsibilities between teams
and the cultural recommendations that have informed the plan.
15“Kaumātua are there for everyone, whānau ora is for everyone
though we say in the case of kaumātua, Māori first.”
Te Korowai Atawhai Team, Canterbury DHB
The second way is where kaumātua are able to successfully advocate for a
collaborative inter-agency approach for positive service delivery results. The
primary health organisations (PHOs) are, in many instances, this first level of
contact. Also many Māori non-government organisations (NGOs) operate at the
primary care level, and as such strengthening the links between PHOs, NGOs and
mental health and addiction services supports the focus on the interface between
primary and secondary services. Kaumātua frequently wear many hats, work as a
kaumātua for many organisations and are therefore not committed to one service.
Indeed they may move fluidly between primary care and secondary care health
services and are able to raise access issues and service appropriateness in both
areas. Again it is important that kaumātua know the role of primary and secondary
care in improving access and facilitating appropriate service delivery models for
Māori.
MULTIDISCIPLINARY TEAM MEETINGS
As a senior staff person with wide experience of human behavior and interaction,
kaumātua are often well placed to mediate within multi-disciplinary teams. When
tensions arise because of role definition, workloads or different ways of
conceptualising a health problem, kaumātua are able to act as mediators, bringing
the focus back to common goals (tangata whaiora) and fostering a spirit of
accommodation and compromise.
In addition, even though there might be a high level of cultural dysfunction, a
kaumātua may decide that higher priority should be given to other aspects of care.
In contrast to cultural support workers, kaumātua are not necessarily advocates for
cultural therapy. Their wider role is to ensure that balance is maintained and that
the team agrees on a plan of treatment and care that recognises priorities in time,
tangata whaiora wishes, and takes into account the relative skills and workloads of
team members.
16“What we bring is cultural expertise, clinical knowledge and background to
assist the kaimahi and tangata whaiora and their whānau.”
Ngāti Kahungunu Kaumātua, Koroua, Kuia me Whaea
TIKANGA MAORI LEADERSHIP AND OVERSIGHT
It is reasonable to expect that kaumātua who are working in kaupapa Māori
services bring advanced cultural knowledge and skills into the workplace with
them. Gaining those skills ‘on the job’ is not advised, nor should that be
acceptable (Te Rau Matatini, 2008b).
Kaumātua need to be culturally fluent to be able to provide tikanga Māori
leadership and oversight to others, cultural interventions such as a cultural
assessment, and the positive outcomes such as strengthening cultural identity that
might be expected to come out of certain cultural interventions such as karakia,
pōwhiri, manaaki, whakawhanaungatanga, whakapapa, or the use of te reo Māori.
Kaumātua must also be positive role models and ready to lead pōwhiri, karakia,
and whakawhanaungatanga on behalf of the team/services/organisation.
CULTURAL SUPERVISOR/MENTOR
Supervision is one way of ensuring health practitioners do take good care of
themselves, which in turn should ensure they will take best care of tangata whaiora
and their whānau. Cultural supervision is about supporting health practitioners and/
or teams to identify relevant cultural issues that may impact on practice and to
explore in a safe environment some solutions to those issues. Kaumātua, in
providing the cultural supervision, will be listening to the issues and the
recommended solutions and will advise on a way forward that will give balance
between the cultural and clinical dimensions of mental health and addiction
practice. Good supervision should improve cultural knowledge and ability for the
supervisee to apply that knowledge into one’s practice.
Kaumātua as cultural specialists can also support in the further development of
cultural scopes of practice and cultural competencies. The Health Practitioner
Competency Act (2003) requires all authorities registering scopes of practice under
this Act to ensure their professionals are competent to practise and to set standards
for measuring that competence. The fundamental basis of this Act is to ensure the
safety of all people in need of health care by health practitioners.
17“I look purely at tikanga, kawa, waiata, karakia, mate Māori and matakite. All things
that affect wairua are part of cultural supervision. One time the Ministry of Health
came to visit. I took the opportunity to hand the tikanga and kawa to those who had
been learning. They had 3 hours to organise things and were able to do it. I was so
proud of them and they felt more confident in being able to move forward
and do these things well.” Papa Huatahi Nia Nia Tairawhiri DHB
The national Ministry of Health Let’s Get Real Skills project for the mental health
and addiction workforce is currently underway. The framework for this provides
both the opportunity for shared commonalities of non-Māori and Māori
responsiveness to Māori as well as points of difference. Nevertheless it is also
imperative that alongside those competencies national Māori cultural core
competencies are added and appropriate training established. Te Rau Matatini and
Matua Raki are developing complimentary culturally relevant, competency
frameworks.
Kaumātua also often provide mentoring roles. It is not unusual for younger Māori
to accompany kaumātua to watch and learn. This relationship is reciprocal as the
younger of the pair will teach the kaumātua new skills, and the kaumātua will teach
the younger culturally appropriate actions and behaviour for given situations. This
type of relationship is reflective of the tuakana-teina principle where according to
the situation and work needed to be done, there is no age limit or barrier on who
is tuakana or who is teina. Tuakana-teina relationships have been viewed by some
kaumātua and pakeke alike as a pathway for succession planning (Te Rau Matatini,
2007a).
Provision of cultural supervision and mentoring can support kaumātua to
contribute greatly in supporting services to identify what is needed for a service to
be culturally responsive and competent to Māori and to align to core cultural
standards against which health practitioner practice can then be assessed.
18“Every second Monday we had clinical meetings and when an issue
came up for Māori that I felt was culturally based and decisions were
being made, I would say to the clinicians at the meeting, ‘hang on,
this has to be passed by the Kaumātua kaunihera’ . I shall always be
grateful to Te Atihaunui-a-pāpārangi Kaumātua.”
Matua Bunny McLean Murihiku and Ōtepoti
KAUMATUA WORKFORCE QUALITIES AND SKILL SET
CULTURAL FLUENCY
“A pre-requisite for competent practice with Māori is a sufficient level of cultural
fluency to ensure that the place of culture in treatment and care, leads to positive
outcomes. Cultural fluency embraces te reo Māori, tikanga and kawa, whānau and
Māori networks” (Te Rau Matatini, 2008b).
The proficient practice of tikanga Māori and Māori models of health in service
provision to Māori is an integral part of clinically and culturally competent
practice. Te Reo Māori is an important factor to cultural fluency. It is through the
transmission of the language that tikanga Māori is preserved. Kaumātua need to
speak confidently in te reo Māori and to use te reo to build mana and strengthen
cultural identity. Where there are situations in which understanding or speaking in
te reo Māori is not strong, the kaumātua will ensure there is opportunity for gaining
competence in te reo if that is important to the tangata whaiora and whānau.
Cultural fluency also provides opportunity for kaumātua to test themselves, not just
in speaking te reo Māori but also in their understanding of Māori models of health
and concepts of Māori risk management – tapu, noa, rāhui, within the dimensions
of marae ātea, te wā, and kawa. Some kaumātua fluency in te reo is limited, yet
they are committed to working with Māori and have strong cultural identities. The
absence of te reo Māori does not necessarily signal a weak Māori cultural identity
(Te Rau Matatini, 2008b).
CLINICAL KNOWLEDGE
Kaumātua should not be expected to know what health practitioners know in
regards to clinical practice. By the same token, health practitioners cannot be
expected to hold the cultural knowledge kaumātua have. However, it is equally
encumbent on both kaumātua and practitioner to be culturally and clinically
competent to improve their cultural responsiveness to Māori.
19“We take a holistic approach based on Whānau Ora.
Kaumātua can self-refer or we receive whānau and community referrals.
Whether kaumātua have mental health or other health disabilities there
is a place here for them. We have Kaumātua who are here to assist and
work alongside koroua me kuia, and their whānau”.
Adrienne Arthur, Kaimahi
Rauawaawa Kaumātua Trust
Kaumātua need to understand tangata whaiora and whānau related policy and
philosophies such as the recovery philosophy and its principles; social inclusion;
reducing stigma and discrimination; the importance of resilience; rights and
responsibilities; whānau inclusiveness in mental health and addiction service
policy and government legislation, and then are able to apply them appropriately
to their practice.
Kaumātua have also commented that in their experience a consequence of not
understanding medical terminology can sometimes be restricting and create
unnecessary barriers in developing and maintaining effective relationships
between kaumātua, tangata whaiora and clinical staff. At times this has affected
the quality of care and level of participation tangata whaiora and their whānau are
able to receive (Te Rau Matatini, 2007a). It is essential therefore that kaumātua
have an appreciation of medical terminology as it applies to tangata whaiora and
whānau and how it may affect their personal choice of treatment and care. This
appreciation will support kaumātua confidence when they advocate for and on
behalf of tangata whaiora and their whānau for interventions that will produce
positive cultural outcomes.
UNDERSTANDING AND KNOWLEDGE OF THE MENTAL
HEALTH SECTOR
Kaumātua access to Māori and their networks puts them in a strong position to
keep Māori informed and abreast of mental health and addiction issues and Māori
mental health initiatives in the community.
Kaumātua knowledge of the environment can be reinforced when, alongside
robust orientation induction workshops, they also gain an overview of the service,
its structure, values, goals and objectives in relation to whānau ora. More
importantly, the opportunity to develop relationships with others in the teams they
will work with will help them create the links that are necessary to ensure access
to services for tangata whaiora and whānau are increased.
20
20“My mother told me when I left the shores of the river Waimana and
came to the South Island that I was to respect the tikanga and kawa of
the local area. That I am Tūhoe and will always be Tūhoe, but I still
needed to respect each iwi, each hapū that I went into. I have always
tried to do that while I have lived and worked in
Waipounamu.” Matua Tahi Takao, formerly with
Canterbury DHB
Another important responsibility is for kaumātua to be able to assess the cultural
relevance of outcome tools. Kaumātua need to have a clear understanding and
knowledge of Hua Oranga, a Māori mental health outcome measure based on the
perspectives of the tangata whaiora, the whānau and the key worker with health
outcomes measured according to taha wairua, taha tinana, taha hinengaro and taha
whānau.
Attending and participating frequently in relevant mental health and addiction
training will go some way to ensuring kaumātua are knowledgeable about
the most current and important issues for prevalence of mental health and addiction
issues as well as barriers to access for Māori. Kaumātua then will be in a stronger
position to better inform whānau, hapū, iwi and Māori communities so they in turn
can find ways and means to address these problems.
ENGAGEMENT WITHIN THE MAORI COMMUNITY
It is preferable that kaumātua have the support of the local iwi or the Māori
community in the work they do with tangata whaiora and the whānau. Gaining
support may take time and effort. Time will need to be committed in order to learn
the tikanga, kawa, and whakapapa of the area. Effort will be made to network,
make the links, visit the marae, work on the marae and attend iwi and/or
community hui. Part of the reciprocity of the iwi or community will be their
support for the kaumātua in the work s/he does and granting access to their iwi/
community resources. At least 50% of the Māori population live outside their iwi
and it is not common for mātā waka to be appointed to roles of leadership based on
the work that has been done over a number of years. As iwi have been organising
themselves and their structures, other iwi have continued to respectfully (in most
cases) fill roles and take leadership positions.
Receiving an iwi and Māori community endorsement also provides a korowai of
safety for the kaumātua and the environment in which he or she works. There are
tangible and intangible benefits and expectations when seeking and receiving
confirmation of community endorsement.
21Qualities that are acquired as a result of working towards community endorsement
include:
• a greater respect for the whenua and mana whenua
• an indepth knowledge of local cultural factors, strong networks and lasting
relationships.
MAORI WORKFORCE DEVELOPMENT
Kaumātua as seniors in the workforce:
• are able to contribute appropriate strategic advice to local, regional and national
forums to strengthen synergies across Māori workforce development initiatives,
and
• have an opportunity to inform and contribute to Māori recruitment and retention
strategies to assist managers to attract suitably skilled and experienced Māori to
the Māori mental health and addiction sector.
Strategies presently underway are aimed to encourage young Māori and tāne Māori
into the mental health and addiction workforce and are designed to reduce the
stigma of working in mental health.
A dedicated kaumātua workforce strategy has been lacking yet attracting kaumātua
into the mental health service is a unique challenge that requires a different
approach. Recruitment is critical due to the ‘‘shrinking pool of kaumātua to draw
on in mental health and addiction services” (Te Rau Matatini, 2006b). This has
become a matter of urgency in order to plan for succession and allow time to train
suitable candidates in leadership roles. Succession planning is vital as kaumātua
are now looking to younger generations for support in their roles and there is a
growing concern that kaumātua of the future may not possess all of the skills and
knowledge to carry out kaumātua duties in the future. (Te Rau Matatini, 2005).
22“The challenges we face are ongoing expectations of being accountable and credible in
the community. So we are currently building on the gains, yet we want to keep a
balance and don’t want it to be a chore. Sometimes contractural expectations have us
feeling like we are trying to put round pegs into square holes”
Rauawaawa Kaumātua Trust Manager Yvonne Wilson
There is a need for appropriate recruitment
strategies to attract potential Māori leaders with
knowledge of te reo me ōna tikanga into mental
health and addiction services. Retaining kaumātua availability to resource the
services will require improved working conditions and a supportive working
environment.
A coordinated approach across a range of workforce development endeavours in
health and the wider sector and also more broadly across the arena of Māori
development is essential to planning for the future Māori mental health workforce.
It is important to build synergies with other workforce development programmes
and health and education initiatives to ensure alignment with a common goal
of whānau ora, to reduce the likelihood of duplication, and to increase cohesion
across the wider Māori workforce.
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